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Ouch! Ready to give up... :( Help please...

Yesterday I posted a lovely message about how I have been trying to wean my 6 week old off the nipple shield (he was never able to latch on at all until just recently) - which has been going quite well all things considering over the past week. However, the last two days suddenly something has changed and my nipples are in major pain when he feeds. Yesterday the pain was only when he first latched on, however today the pain doesnt seem to disappear at all. It seems like he has forgotten how to latch properly - and even when he gets on, he doesn't really suck the way he was doing before - just sort of suckles - not the deep sucks he was doing before - and no real swallowing noises anymore.

Could this be thrush? I dont seem to have any other symptoms other than pain when he eats - they aren't really sore to the touch except for the tip... which still makes me believe that his latch has changed somehow. I think that he is not pulling enough of my breast into his mouth anymore.. even when I go back to the nipple shield, he doesn't seem to eat well right now either though...

I visit the bf clinic weekly and have done so much reading and gotten so much advice from 'professionals' that nobody seems to be able to tell me anything new or different to try to improve his latch.

AHHHH! please help - I am going mental and getting really sick of crying every day about my newest bfeeding problem (especially one that hurts)...

Re: Ouch! Ready to give up... :( Help please...

Originally Posted by lf105

It seems like he has forgotten how to latch properly - and even when he gets on, he doesn't really suck the way he was doing before - just sort of suckles - not the deep sucks he was doing before - and no real swallowing noises anymore.

How are his diapers? Is he having 5-6 WET diapers in a 24 hour period? My DD did this when she became dehydrated, which started a vicious cycle - too weak to suck efficiently, which led to not getting enough milk, which changed her latch since the "reward" was no longer coming out, which meant even less milk, and so on and so forth.

If you're unsure of what a truly wet diaper feels like, put a minimum of 2 tablespoons of water in a fresh clean diaper to get a feel for it. Between 2-4 tablespoons in a nice wet diaper. When my LC told me this I went home and did it, then kept a feeding/diaper diary and was SHOCKED at how poor her diaper output was. Everything clicked at that point (at least for me). Once she was given a supplement she perked right up and was much more efficient at the breast. My only problem was that she wouldn't latch with the SNS, so weaning her off the supplementing was hard, but we did it.

I would first make sure he is getting enough, and then go from there. If it is just a latch issue you can work on that. But if it's a latch issue coupled with dehydration and lethargy, you'll need to help him out a little so he has his strength to really suck.

Re: Ouch! Ready to give up... :( Help please...

Even though dd's latch was good, I found the first while very tender because, well, my nipples just weren't used to that much usage! After a while it went away and I'm fine. Maybe it's just the switch from the shields to bare flesh?

Re: Ouch! Ready to give up... :( Help please...

First, I went back and read your post from yesterday. Wow! You said your baby has gained 3 pounds in his six weeks of life. I am assuming you meant he's gained 3 pounds above and beyond his birth weight - so he may have actually gained more if he initially lost an ounce or two in the first week or more. We like to see babies regain birthweight by 2 weeks of age and the average weight gain for a North American baby is about 1 ounce per day for the first month. So your baby has exceeded expectations on that account, making me believe your milk supply is great!

You also mentioned your baby was tongue-tied, but you didn't say whether his tongue was clipped (frenotomy) or not. Not all babies with tongue tie need to have this procedure, of course, but some do. Sometimes an LC will ask a mom to use a nipple shield on a baby with tongue tie, in order to allow the baby to get a good latch despite the slight disadvantage of not being able to fully extend his tongue. Babies who gain well in the first few weeks, even with anatomical problems like you describe (his tongue tie and your flat nipples) sometimes are thriving because their mom has a great milk supply.

Nipple shields are also often used to help babies whose moms have flat nipples. When your nipple reaches the junction of his hard and soft palate, way in the back of his mouth, that is when his suckling is stimulated. Sometimes the shield can assist with getting that feeling in the back of his mouth. In the meantime, as you continue to breastfeed him, the skin on your nipples is gradually being pulled out. This can also be helped by pumping with an electric breastpump. Have you been pumping to assist this process?

One of the best pieces of advice I have read about weaning from a nipple shield is that a baby will stop using a shield when he is ready. I know that may sound trite and simplistic right now, but I have seen it proven over and over again. You are certainly doing the right thing when you give him daily opportunities to feed at the breast without the shield. But don't let yourself experience the pain you are describing. OUCH!! Breastfeeding should not hurt.

If you didn't have your baby's frenulum clipped, you may want to ask your LC to refer you to a health care provider who performs frenotomies in order to see if that procedure would allow you to breastfeed well without the shield. Also, as others have said, your baby may be getting more milk and more milk faster without the shield than he was when he was using the shield. That may explain the shorter nursing time. But it doesn't explain the pain and that is a concern. Pain during breastfeeding is always a warning to get help. The pain is most frequently related to a latch which needs to be adjusted. In your case, the latch adjustment may be fixed by a frenotomy or you may need to work on helping your baby to get a deep latch. If a baby is not latched well, there will be friction between the inside of his mouth and your breast...resulting in...PAIN.

If you are not experiencing this pain when you are using the shield, I would advise you to continue using the shield when you have the pain. You sound like a mom who is willing to go the distance to get this baby to feed well and I believe your persistence will pay off. Give your baby some time to wean from the shield more gradually and unlatch your baby if you feel pain.

You can work on the latch yourself. Diane Wiessinger is an IBCLC and LLL Leader who has a website with many helpful information sheets. I love her description and drawings of a good latch which can be found at <http://www.wiessinger.baka.com/bfing/howworks/latchtalk.html>.

Re: Ouch! Ready to give up... :( Help please...

I just wanted to offer encouragement. My ds was also born tongue-tied. We had the frenotomy procedure in our (family practice) doctor's office. No anaesthesia. It was minimal pain and only one drop of blood for my son. It took another week before I was able to get him to latch on, as I also have flat/inverted nipples. Two weeks later we began weaning off the nipple shield. He learned to give a good, strong suck at the beginning of each nursing session to pull the nipples out. I think it took about 2 weeks to wean off it completely. One nipple was trickier than the other.

Not ready to give up: Ouch! Ready to give up... :( Help please...

Everyone - thank you SO much for all the responses... Things have gotten MUCH better in terms of pain - in fact within a day after I posted this, the pain was virtually gone.. I still occasionally get a little momentary pain when he latches on, but everything else is fine...

Also to give everyone a little history, I did get his tongue tied 'snipped' when he was about 5 days old, and yes, I do have flat nipples, but he has definitely learned to latch - sometimes he latches on immediately, sometimes it takes a few minutes. Also, yes, I have been pumping since day 1. The first month, I was using a rental electric and pumping several times a day. Now I use a manual pump only about once a day (usually overnight when my breast are SO full that my son can't latch on at all). When this happens, I can usually pump 4 to 5 ounces without even emptying my breasts.

However, I am still a little worried about his feedings.. His feeding times are even shorter now.. Usually he only feeds about 2 minutes on each side now. As well, he goes on and off the nipple so many times during a feeding that its hard for me to judge how much he has gotten. On average, he only has about 2 feedings a day where he feeds for about 5 minutes straight - and usually on just one breast. He generally only ends up playing with the other side at that point. Thing is he still has a fairly wet diaper at every single feeding (about 7/8 a day) and poops significantly at least once - often twice - a day. From day one I have kept a journal and his output has remained pretty constant since he was born. As well, he always seems satisfied and doesn't want anymore. So strange...

We have been fixtures at the breastfeeding clinic but now that he can latch and he's almost 7 weeks old, our days there are done. They didn't seem concerned at his short feedings, but I of course am concerned and somewhat amazed that this kid is getting any food at all! So my only support now it seems are other mothers...

I hate to say I had the thoughts of giving up, I now know I was silly to even say that b/c I know I will never give up - UNLESS my ds is not thriving.

Any more words of wisdom? Again, my big concern now is why his feedings are so 'weird' and short.

Re: Ouch! Ready to give up... :( Help please...

Forgot to mention something, when I say he is only feeding for about 2 minutes on each side - that is just my guess since he usually does about 3 or 5 small gulps at a time and will either pull off (my milk is often very fast and I know he doesnt like that) or just pause for what seems like forever. I usually try to feed him for about 20-30 minutes sometimes even up to an hour if he's sleepier.. This again is why I can't tell how much he actually gets since we rarely have a feeding where he is constantly sucking for a longer period of time. Also, every day is a bit different, the last few days its about 5 minutes total (if that), but the couple of days before that, he was consistently eating for about 4 minutes per side (constant).

Re: Ouch! Ready to give up... :( Help please...

I'm glad to hear things are better for you.

As far as your ds not nursing for long durations, it shouldn't be an issue as it sounds like his weight gain and diapers look good. Is there any way you can weigh him before and after a feeding? That may help to put your mind at ease.

Re: Ouch! Ready to give up... :( Help please...

I'm so glad that things are going so much better now -- kudos to you for hanging in there and working to find the support that you needed.

Your baby's very short feedings probably have something to do with the fast flow of your milk. As you have noticed, he comes off the breast frequently, and this is probably his way of taking a break when the milk flow becomes too much to handle. I suspect that he is probably better than the average baby at eating quickly, and that skill combined with your fast letdown is what allows him to get all the milk he needs in just a few minutes. You are very wise to watch his diaper output, as that will always be the most reliable way to gauge his milk intake.

The long pauses at the breast probably just indicate that he enjoys being close and having the breast in his mouth even when his tummy is already full of all your wonderful milk. You may notice that his suck changes between actively eating and light comforting sucks. Both are good for a baby, so just let him lead the way as long as he is thriving.